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Guess Who’s Educating Your Doctor?

It’s no secret that drug companies sponsor medical conferences and seminars. But a new report by Australian broadcasters shows how drug companies also help select the speakers at those events.

The reason it matters is that conferences are often where doctors go for continuing medical education. “It seems that invisible influence may be flowing through these sponsored seminars — even those accredited by august associations — far more often than many of us realize,” writes Ray Moynihan, a lecturer at the University of Newcastle in Australia and a visiting editor at the British Medical Journal, where the article appeared. “It is not uncommon for drug company sponsors to suggest speakers at sessions that are assumed by the thousands of general practitioners who attend them to be totally independent.”

The article describes the “invisible” influence of drug companies in doctor education. It cites e-mails between conference organizers and drug firms in which the drugmakers suggest specific speakers for the education programs.

One example, outlined in a background briefing report by the Australian Broadcasting Corporation, highlights a talk given by a doctor at a continuing education program at the University of New South Wales. The doctor makes several casual references to the diet drug Duromine, which is the Australian brand name for the weight-loss drug phentermine.

“While the weight loss drug was mentioned more than half a dozen times, what was not mentioned to the doctors present was the fact that the company marketing Duromine, called 3M, as part of its sponsorship package, had paid for the right to suggest speakers for the session,” the report explained.

The broadcasters go on to cite e-mails showing that the drug firm was directly involved in helping the doctor prepare his educational talk.

None of this is shocking, but the Australian report provides an interesting glimpse into the vast reach drug firms have in the training of doctors around the world. And while doctors often are blamed for having relationships with drug firms, the report shows how many doctors who believe they are receiving independent information are unwittingly being educated by drug company representatives.

To read a transcript or listen to an audio file of the report, click here.

As a practicing surgeon, incidents like this drag the entire profession down. While we realize that industry is important in helping to fund symposia and national meetings, the educational content of these should be completely free of industry influence.

Most medical and surgical specialties, as well as many major jounals, have increased the transparancy of their conflict of interest reporting so that these sorts of problems will be avoided.

Ethical physicians should insist that continuing medical education events be free from corporate bias and sponsor influence, unless they are clearly and unambiguously labeled as such.

A bit alarmist using the title of “Guess who’s educating your doctor”, isn’t it? I mean come on, modern physicians, myself included are HIGHLY skeptical about any new technology or med that comes around as most are expensive and don’t work any better than old treatments or common sense. So who’s educating today’s doctor? It’s a part med school, unbiased medical journals, residency and mentors, and a ton of life lessons, long hours, and patient care. Come on. We’re not in business with drug companies, we don’t get “kickbacks” like is so often suggested (or at least no one I’ve ever known or work with), and we’re not out to fleece the public. Give me a break.

I am not a doctor, but many members of my family are. These are the brightest and most skeptical people in the family. Even if the speakers are selected by the drug companies, I doubt it very much that these bright savants will be fooled by any such efforts. I have seen these people check out any new information a dozen different ways before accepting any; and even then they are fully aware of associated constraints. The days of drug companies pulling wool over physicians’ eyes are numbered.

As a physician, I always plan to ignore the drug reps and think that I am above being influenced by them.

However, we are all human and subject to emotional responses. Who wouldn’t have nice feelings about a product if it was constantly associated with good food and company?

The pharmaceutical companies keep a close track on sales and marketing. They constantly crunch the numbers and there is a reason that they spend all the money on seminars and “educating” physicians. They know it gets results.

I think it’s important to make the distinction between Australia and the US. What types of rules does Australia have governing CME activities? Is it similar to the US? The US’s Accreditation Council for Continuing Medical Education (ACCME) says that “A provider cannot be required by a commercial interest to accept advice or services concerning teachers, authors, or participants or other education matters, including content, from a commercial interest as conditions of contributing funds or services.” (accme.org) This certainly doesn’t mean an event sponsor won’t ask a pharmaceutical company to suggest speakers, but I think it helps increase independence from pharma influence. In my experience, the ACCME rules are taken seriously by organizations creating programs, organizations providing CME approval, and pharmaceutical companies. (Work for a nonprofit that provides monthly CME programs for clinicians).

And does pharma provide “educational grants” to your non-profit Christine, provide materials for you to use and/or give out, or act as resource for you in any manner? Does any member of your staff lunch with pharma? Are drug reps welcomed into your offices? Do they bring food, gifts (no matter how small) to any member of your staff? Can you pick up the phone and call someone at pharma for consultation on any aspect of treatment for your community or any help in any manner even responding to a question? Do they fund or contribute money or goods to any of your fundraisers, provide volunteers to help you out in any way…

If so, you don’t work for a non-profit, you work for the marketing department of a pharmaceutical company.

You don’t walk into a Ford dealership expecting to get an unbiased opinion about a similarly priced Honda. I’ve never walked into a grocery store where the clerk told me the supermarket down the street has better quality tangerines.

I believe doctors are getting more savvy about the myriad ways that drug companies try to influence their prescribing, despite what the alarmists like to say. That can only be to the benefit of patients overall, though in the spirit of justtheERdoc’s comment one cannot reasonably expect a business (the drug industry) to decide to not try to sell its products. I can’t tell you how many times a drug rep has stopped me in the hallway of my office building trying to sell me something that is either 1) unproven or unsafe, or 2) more expensive compared to similar generics, or 3) marginally better than other treatments or no treatment at all. What do I do after talking to the rep? Cower in the corner until the evil drug rep goes away? Scrub my hands with bleach to cleanse my tarnished soul?

No, I use my brain. I am automatically skeptical about the information they hand to me, just like I would be walking into an insurance office and ask about their policies. I take the time to read the actual studies behind the colorful posters and handouts they post up. I look up the financial disclosures and funding from which the study was conducted. I go to PubMed and the Cochrane databases to look at similar studies and read previously published data on the subject and (even better) meta-analyses. I carefully look at the patient population studied as too many drug studies look at ideal or mildly ill populations to make their results look better, or use unusually low doses of drugs to make their products appear safer. I typically do my own statistical analysis of effect size and NNT and look at generalizability to clinical practice to determine whether the “results” actually mean what the authors purport they mean.

This isn’t brain surgery (unless you’re reading a neurosurgical journal of course), it’s EBM, and should be a tool every doctor can pull out of his or her pocket to reliably weigh data. I would propose that medical schools and especially residencies train future physicians on EBM techniques as well as basic economics and marketing, to arm them against the pretty drug reps who will descend on them once they have prescribing privileges. That said, I think it would be as naive to expect Big Pharma to scale back their sales tactics as it would be for Microsoft or Toyota or McDonalds. But training current and future doctors in the art of skepticism would go a long way towards restoring the public’s confidence in the science of medicine.

Jatinder Seghal — many members of my family are doctors too. And, while I would really like to believe that they are above being influenced by tricks such as these, the odds are against it. Doctors are smart and highly educated, but they are also human. The means that the pharmaceutical companies use to influence doctors are subtle and pervasive — when something becomes routine and constant, you stop noticing it. And, in many cases, that’s what’s happening. Doctors become used to the constant background noise of drug reps/drug advocates — and some of what they are selling seeps in unconsciously. I think this has to happen — I personally don’t want doctors spending all their time (although they should spend some of it) dissecting this stuff. They need to spend time with (and on) their patients as well. To maintain their credibility, conferences should at least severely limit the ability of drug companies to choose speakers. For an event that claims to provide continuing education, this is properly their responsibility.

As a medical student, I hope to learn how to do what is best for my future patients. Thus, I expect my education to have the good of the patient at its center. However, as a student I see the ways in which pharma influences faculty and residents by financing ‘educational’ meetings, meals, and speakers. Academic medical centers must lead the way to ensure that our patients can trust their physicians to what is best for them and not what profits industry.

I reject invitations to medical education events sponsored by pharmaceutical companies and those featuring speakers known to have Big Pharma ties.
Most, but not all, physicians can think critically enough to filter out propaganda delivered by the pharmaceutical industry. Unfortunately, there still are docs influenced by free pens, free lunches, free dinners and conferences held in exotic locales.

There have been a # of articles with the same theme:”Doctors are beholden to the Drug Companies,…they recieve lavish gifts, dinners, etc. etc…”…Since 2002 there have been major changes, and the pendulum has swung so far the other way, that there are very few lecture dinners anymore..no trips…no gifts(except ballpoint pens)..These areticles are off base and 6 years out of date…..M.D. in Midwest

Yes NR, I’m well aware of nofreelunch.org. I’m a supporting member, as are many of the other physicians I work with. There are no drug reps in our department, a couple have tried but have been escorted out. They don’t bring us food. They dont buy us books. We are far too busy with patient health care to be burdened with humoring them. We don’t use their pens, don’t read their handouts. And the trips to CME conferences we pay for ourselves our out of our CME fund that is part of our salary (not paid for by pharm companies). Any “industry sponsored” research (read as “pharmaceutical company paid for 20 studies to be done and published the best report”) loses much if not all credibility in the medical field, so it gets sent to the bottom of the stack of literature we need to read every month to stay current.

The direct to patient TV ads for drugs need to be seriously regulated or just pulled all together.

I smell corruption, and it’s not just with the phamra companies – it’s with all large companies and governments these days, our own included. What kind of example is this setting for us and our kids!? Not to mention the pattern laid for the future!

When I do come across someone who does take responsibility, which is increasingly rare, and they own up to a short coming, I thank them for being honest and for accepting responsibility.

I remember as a child, when we did something wrong and pointed fingers, we all got punished – equally. I took that to mean “integrity” far outweighed the wrong act we did.

I’m living in a world where plenty of horrible things happen through the hand and behavior of mankind and not a single person is responsible for the negative results!? Gimme a brake!

Realizing and accepting that we’ve been duped and admitting it, makes us look like fine, good, and honest people. When we keep denying it we leave ourselves wide open for repeating our mistakes and shortcomings.

When I see finger pointing, I often say, “what do you think I am stupid!? I know YOU are responsible for the role you played.”

It’s amazing just how many people today are terribly uncomfortable accepting “they” played a role in something that turned negative – but everyone wants their piece of the cake when it’s something joyous or good!

This has nothing at all to do with ones intellect level or their ability to think critically, or lack of either. It revolves around ego and lack of acceptance, how sad. The absence of integrity.

In the meantime, big pharma… keep your drugs, I’ll have two sugar pills and I’ll call you in the morning.

New years 2007 my uncle, a Dermatologist, visited a conference at Willard Hotel here in Washington DC. Thats the hotel across the street from the White House. The day before New Years included a dinner at Citronelle, the most expensive restaurant in DC, and for new years they rented out the entire ESPN sports bar. Everything was completely payed for by pharmaceutical companies.

Well, I see no problem with drug companies sponsoring medical education. Why is it that you are not talking about Medicare cuts for medical education? How do you expect to train residents in all specialties and yet continue cutting funds for their education? Because of budget cuts in Medicare, hospitals are decreasing didactics and simulations. Residency programs are losing funds for medical textbooks, providing for specialty memberships, and access to medical journals for residents. And because of medical liability, you can’t expect a fresh new medical intern to practice a procedure on his first patient. As long as the President and Congress go along with cuts for medical education, someone has to pick up the tab. And yes, drug companies try to influence the prescribing and ordering practices of physicians. But during conferences, sponsored events not only talk about that particular drug or device, but about other aspects of that specialty (that have nothing to do with any drug or device) that are beneficial for the knowledge base of a physician when treating a patient. And how about medical research? If funding for the NIH continues to decrease, someone has to pick up the tab. Why do you think that most research today involving drugs are indeed sponsored by drug companies?

Most of the docs I know who play the game play it with multiple drug companies. They speak for the companies, attend their educational functions, listen to their drug representatives, and accept samples.

Thus, most docs are getting info from multiple competing sources. This scenario is thus a far cry from the image most people have of docs being bamboozled by a single drug company to prescribe a single brand-name drug.

In her book, The Truth About Drug Companies, by Dr. Marcia Angel, she discloses this and many other sleazy practices which are common to big pharma. Many doctors are for sale and this, unfortunately, includes the highly respected and most honored. Indeed, they are deliberately chosen because of their sterling reputations…the easier to influence their colleagues.

Patients see physicians to diagnose and treat their clinical conditions.They expect advice that is in their best and sole interest.

Physicians and drug companies see patients as revenue streams. Physicians also see patients for other reasons.

Drug companies are beholden and responsive to stock prices, stockholders, market conditions and Wall Street analysts as exemplified by the recent Jarvik campaign to keep an expensive brand name on the prescription pad versus the lesser cost and as effective generics that now exist and the generics expected after the paritcular Jarvik campaign brand name patent expires in 2010.

The issue is that physicians are being influenced to prescribe drugs as the one and only way to treat disease. In the Jarvik campaign, the goal was to keep physicians writing prescriptions for one specific costly drug. By going direct-to-consumer, the pressure was also being sought by making consumers demand the branded prescription. This has nothing to do with the goal of the patient to get independent advice for their sole benefit. And as these drugs come under greater independent review, their value comes into greater question (see placibo vs drugs used for psychiatric conditions, the back ache study conclusions, etc. all reported in the Times or get a copy of a presentation on this and other aspects of quality and costs by e-mailing healthinfo@delhitel.net, with presentation request in the subject line and name and phone number in the text section.)

As in the now more widely known senario based on an insider in that industry, cigarettes were just the nicotine delivery system, so the physician has become willingly or not the licensed and regulated drug pusher, the cigarette of choice so to speak.

Many prescription drugs are potentially dangerous according to gold standard and other studies, some even paid for by the drug industry companies.

Alternatives to drugs are buried in this avalanche of (mis)information, subtle and directed advertising, etc. If it did not work, why would the industry spend billions in this way? Why did the company spend over $350 million on the Jarvic campaign alone? And why are is the company going ahead with its next campaign as the Jarvik campaign had to be ended (again reported in the Times)?

Of course there are physicians who have stayed true to their oaths and professional ethics. But by defending themselves, by implication assuming others act as they do, and not demanding that the profession clean up its act, they become guilty by their asssociation and silence.

After WWII, there were no Nazis, there were only good soldiers following bad orders from above.

In this case, there are no bad physicians. There are only dedicated physicians who take trips, accept money as consultants and speakers or are involved in research or public health education advocacy organizations like the American Heart Assdociation or the American Cancer Society that accept grants, gifts and other forms of financial support. Thses physicians and organizations seem to think that the money is innocent and has no effect on them or the patients/publics they serve.

Anyone who buys into that line of reasoning should refelct on what they are doing and its impact on the dignity of the medical profession, the cost of medical care received (MCR) and the quality of care in America that continues to fall in comparision to other countries.

According to one doctor, who now sees the light on the link between a plant-based diet and nutrition writes: “I know that when I was in medical school, nutrition education consisted of little more than a passing reference here and there. Unfortunately, even though our understanding of the relationship between diet and health has grown exponentially, medical training generally has not caught up with current understanding.”
Many have confirmed this opinion. Read, ” Doctors Get Poor Marks in Nutrition,” New York Times, //query.nytimes.com/gst/fullpage.html?res=9F0CEED8143CF933A25751C0A965958260&sec=&spon=
More recent studies confirm that nutrition is given short shrift in med. school.
If we really want to look at the influences on doctors, or lack of thereof in a good sense, we need to look at this.
In my life, I have yet to have a doctor suggest that eating a more plant-based diet could help my condition, whatever that might be at the time. I learned this on my own.
All the clinical evidence is there: The consumption of animal-based foods is a catastrophe for human health and the underlying cause of most debilitating conditions and early death. Yet doctors remain clueless.
A number of studies have been done, I know.
A simple Google search: little training doctors nutrition “medical school”
will bring up a treasure trove.
A vegetarian diet, of course, greatly reduces a person’s carbon footprint and is immensely more humane.

I almost died from being given the drug amiodarone off-label for atrial fib. I also used to write for a Continuing Medical Ed company and Glaxo flew doctors first class to speak at their meetings. Every courtesy was extended, let us say–including having us make hundreds of slides for the doctors’ presentations. In the sixties, I think there were 600 drugs available–now there are more than 2500. Doctors are inundated with “education.” Any patient can smell the pizza wafting as the detail people bypass patients in the waiting room to get to the inner sanctum. Come on–we all know this. All I can say is: Look up drugs for yourself. See what you are getting into. Be smart. Yes, doing research when you are sick is difficult, but it could save your life. Also–talk to your pharmacist. He or she may know more than your physician about who is coming in with what side effect. I remember getting out of the hospital from one hospitalization from amiodarone side effects (diagnosed as late-onset asthma) and the pharmacist telling me, “I was so worried sending so many drugs home to you.”

Evelyn Vincent: Since you distrust “Modern Health Care” I suggest you forgo all sanitation – water treatment, different pipes for water and sewerage, sewerage treatment, food inspection, pasteurization of your milk, refrigeration of your foods during transport or storage,and dont forget about your immunizations, etc. We wont even talk about your risk of surviving child-birth, or death from accidents. These are all the product of “modern health care” that you decry so loudly. This is the reason that average life-expectancy went from the 30s and 40s of a century ago to now heart disease and cancer. You can now survive those dangerous years to die of diseases of longer living.

The concern has been that some of these CME events receive funding from pharmaceutical companies. They may influence the discussion in that there is a discussion – say, about hypertension or dyslipidemia and the role of a class of medication. It is the role of medical school and residency to teach the physician HOW to evaluate the data. These lectures present data, generally in support of that class. Depending upon who is there, there can be some lively discussion about limitations and other options.

And, there is a difference when approached by pure marketing, the pharmaceutical representative, e.g. in the office or hospital. (I have absolutely no problem skewering their “presentation” for what is NOT mentioned.)

What is not mentioned, which is more problematic, is that many, if not most clinical studies are at least partially supported by various pharmaceutical companies rather than a purely neutral party as the NIH. The pharmaceutical company may contribute, e.g. statistical evaluation of the data and may have some editorial input in the language used in reporting data.

By the way, how do you change your opinion of your auto after you go to the local Car Show? Do you automatically go out and change your car to whatever you thought looked so cool? I suspect not, but you look at the new features, what’s in the pipeline, learn about it and consider some of those in your considerations for another date.

Granted speakers should be transparent about their ties to drug companies so that doctors can make more informed decisions on the source of the information they are receiving.

However, doctors are intelligent trained health care professionals and take a personal responsibility to verify and check the information they use and employ in their practice. This can be done through peer reviewed journals, etc. If they do not do so, do not seriously think about the quality of information and of the source of that information, it’s unprofessional conduct. As an aspiring pharmacist, I would never make a decision based on just one lecture from one “expert.” People’s lives are in our hands.

I educate myself by reading medical journals. On the rare occassion when I have the time to attend a free medical conference sponsored by a pharmaceutical company, there is no doubt in my mind that the individual speaker has been influenced by his parent company. To keep this all in perspective, less than 1 % of my medical education comes from listening to speakers at free conferences offered by the pharmaceutical companies. Let me end by saying, the next time you or one of your family members need a medicine, who are you going to turn to? Be careful about biting the hand that provides you and your family with medicine when you need medicine.
Lee Brown, MD
Emergecny Medicine Physician and Family Medicine Physician